Komplike Akut Apandisit ve Yoğun Bakım Ünitesi Yatışında Laboratuvar Tabanlı İndekslerin Karşılaştırmalı Performansı

Öz

Akut apandisitte (AA), komplike hastalık veya ağır klinik seyir riski taşıyan hastaların erken belirlenmesi klinik yönetim açısından önemlidir. Bu çalışmada erişkin AA hastalarında C-reaktif protein/albümin oranı (CAR), kan üre azotu/albümin oranı (BAR), hemoglobin-albümin-lenfosit-trombosit (HALP) skoru, nötrofil/lenfosit oranı (NLR), trombosit/lenfosit oranı (PLR) ve sistemik immün-inflamasyon indeksinin (SII) komplike akut apandisit (KAA) ve yoğun bakım ünitesi (YBÜ) yatışını ayırt etme performansları karşılaştırıldı. Bu retrospektif, tek merkezli kohort çalışmaya Ocak 2019-Aralık 2023 tarihleri arasında acil serviste AA tanısı alan erişkin hastalar dahil edildi. Birincil sonlanım KAA, ikincil sonlanım YBÜ yatışıydı. Ayırt edici performans ROC analiziyle değerlendirildi. KAA ile ilişkiler, indekslerin sürekli değişken olarak kullanıldığı yaş ve cinsiyete göre düzeltilmiş lojistik regresyon modelleriyle incelendi. Değerlendirilen 701 hastanın 675’i çalışmaya dahil edildi. KAA 223 (%33,0), YBÜ yatışı 28 (%4,1) hastada saptandı. KAA için en yüksek AUC CAR’da bulundu (0,853; %95 GA 0,822-0,885) ve CAR diğer tüm indekslerden anlamlı olarak üstündü. CAR, KAA ile en güçlü pozitif düzeltilmiş ilişkiyi gösterdi (IQR artışı başına düzeltilmiş OR 5,146; %95 GA 3,795-6,979). YBÜ yatışı için en yüksek AUC BAR’da saptandı (0,868); bunu CAR (0,846), PLR (0,838) ve HALP (0,803) izledi. CAR KAA’yı ayırt etmede en yüksek performansı gösterirken, BAR YBÜ yatışı için en yüksek gözlenen AUC değerine sahipti. Bu indeksler klinik değerlendirme ve görüntülemeyi tamamlayan yardımcı risk sınıflandırma araçları olarak değerlendirilebilir.

Anahtar Kelimeler

• Akut Apandisit
• C-reaktif protein
• Albümin
• Prognoz
• Acil servis

Comparative Performance of Laboratory-Derived Indices for Complicated Acute Appendicitis and Intensive Care Unit Admission

Öz

Early identification of patients with complicated disease or a potentially severe clinical course is important in acute appendicitis (AA). We compared the discriminatory performance of the C-reactive protein-to-albumin ratio (CAR), blood urea nitrogen-to-albumin ratio (BAR), haemoglobin-albumin-lymphocyte-platelet (HALP) score, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII) for complicated acute appendicitis (CAA) and intensive care unit (ICU) admission. This retrospective single-centre cohort study included adults diagnosed with AA in the emergency department between January 2019 and December 2023. CAA was the primary outcome and ICU admission was the secondary outcome. Discriminatory performance was assessed using receiver operating characteristic analysis. Associations with CAA were evaluated using age- and sex-adjusted logistic regression models with indices entered as continuous variables. Of 701 patients screened, 675 were included. CAA occurred in 223 (33.0%) and ICU admission in 28 (4.1%) patients. CAR had the highest AUC for CAA (0.853, 95% CI 0.822-0.885) and significantly outperformed all other indices. CAR showed the strongest positive adjusted association with CAA (adjusted OR 5.146, 95% CI 3.795-6.979 per interquartile-range increase). For ICU admission, BAR had the highest observed AUC (0.868), followed by CAR (0.846), PLR (0.838), and HALP (0.803). CAR showed the best discrimination for CAA, whereas BAR had the highest observed AUC for ICU admission. These indices may support, but should not replace, clinical assessment and imaging.

Anahtar Kelimeler

• Acute Appendicitis
• C-reactive protein
• Albumin
• Prognosis
• Emergency department

Kaynakça

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